Original Articles Korean Circulation J 1998;2811:1820-1827 두개외경동맥협착증에대한스텐트삽입술의추적결과 윤영섭 1 홍범기 1 최동훈 1 김선호 2 김동익 3 김승민 4 장양수 1 심원흠 1 Follow-up Results of Stent Placement for Extracranial Carotid Artery Stenosis Young-Sup Yoon, MD 1, Bum-Kee Hong, MD 1, Dong-Hoon Choi, MD 1, Sun-Ho Kim, MD, 2 Dong-Ik Kim, MD 3, Seung-Min Kim, MD 4, Yangsoo Jang, MD 1 and Won Heum Shim, MD 1. 1 Division of Cardiology, Yonsei Cardiovascular Center, 2 Department of Neurosurgery, 3 Radiology, 4 Neurology, Yonsei University College of Medicine, Seoul, Korea ABSTRACT Background and ObjectivesCarotid artery stenting has evolved as a potential alternative to carotid endarterectomy in patients pts with significant carotid artery stenosis. We evaluated the feasibility and long-term outcome of carotid artery stenting in selected pts at high surgical risk. Materials and MethodsBetween May, 1996 and September 1998 we performed carotid artery stenting at 35 lesions in 25 pts. There were 23 males and 2 females. Mean age was 63.26.6 range 5477. Eight four percent 21/25 of the pts had significant coronary artery disease. Sixty four percent 16/25 of the pts had significant peripheral artery lesions. Sixty percent 15/25 of the pts had neurologic symptoms or non-disabling stroke. We used Wallstent in 32 lesions and Palmaz stent in 3 lesions. Carotid stenting was undertaken in 33 internal carotid, 1 common carotid and 1 external carotid lesions. Bilateral carotid stenting was undertaken in forty percent 10/25 of the pts. Results Carotid stenting was successful in all lesions. One patient died due to massive cerebral hemorrhage 3 days after carotid stenting, who had und-erwent stenting as a rescue procedure for failed endarterectomy. One major stroke developed during procedure with partial recovery. For the combined endpoint of strokes and death within 30 days of procedure, the incidence was 8 and 5.7 in terms of pts and procedures, respectively. On follow-up 127 months, we found neither neurologic complications nor death. Angiographic and/or duplex sonography which were performed at 5.5 month in all 18 eligible pts with 24 lesions revealed no evidence of stent deformity or restenosis 50 of diameter stenosis. Mean angiographic stenosis was 20 on follow-up angiography. ConclusionCarotid artery stenting can be performed with high success and low complication rate in pts with significant carotid artery stenosis especially at high surgical risk. Follow-up clinical outcome of average 12 month was good with low restenosis rate. Korean Circulation J 1998;2811:1820-1827 KEY WORDSCarotid arteries Stenosis Stents Carotid endarterectomy. 1820
서론 대상 대상및방법 방법 1821
결과 임상특징 1822 혈관조영및시술결과 Table 1. Baseline clinical characteristics of patients N % Patients 25 100 Mean agerange, year 63 5477 Male 23 92 Coronary artery disease 21 84 Peripheral artery disease 16 64 Hypertension 16 64 Smokerwithin 1 year 21 84 Dibetes 8 32 Hypercholesterolemia 14 56 NASCET exclusion criteria 22 88 Symptomatic 15 60 TIA 4 16 Stroke 11 44 Previous endarterectomy 1 4 Bilateral carotid stenting 10 40 Combined coronary stenting 8 32 Hypercholesterolemia:total cholesterol200 mg/dl Korean Circulation J 1998;2811:1820-1827
Table 2. Target lesion characteristics N % Total 35 100 Right common carotid 1 3 Left external carotid 1 3 Right internal carotid 16 46 Left internal carotid 17 49 Bilateral carotid 11 44 Table 3. Angiographic results Unitmm Reference artery diameter 5.00.6 MLD, prestent % diameter stenosis 1.30.97812% MLD, poststent % diameter stenosis 4.81.2 4 8% MLD, follow up % diameter stenosis 4.01.420 7% acute gain 3.51.3 Late loss 0.80.518% MLDminimal luminal diameter 추적관찰결과 고찰 1823
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